The American journal of emergency medicine
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Every year, nearly 250000 atrial fibrillation patients require temporary interruption of anticoagulation therapy for invasive procedures, acute illness, or bleeding events. Rivaroxaban is an oral anticoagulant that works by inhibiting factor Xa leading to a blockage of thrombin production, which inhibits platelet aggregation and thrombus formation. As with other anticoagulants, there is an increased risk of a thrombotic event occurring when rivaroxaban therapy is temporarily interrupted (TI) or prematurely discontinued. ⋯ The ROCKET AF study showed that there was no detectable difference in the risk of stroke and systemic embolism for participants treated with rivaroxaban vs warfarin undergoing TI. Another analysis suggested that the risk for stroke from TI is probably higher in the rivaroxaban group with 3 to 30 days discontinuation. Alternative anticoagulation therapy such as bridging should always be considered when stopping rivaroxaban.
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Our patient is a 42-year-old woman with muscle paralysis, muscle weakness, and fever. On admission, a neurologic examination showed proximal and distal weakness in the leg. Serum creatine phosphokinase and serum myoglobin level were markedly increased (5600 UI/L and 5197 UI/L, respectively). ⋯ Serologic studies for virus titers showed the antibody immunoglobulin M cytomegalovirus. Muscle weakness and its paralysis, fever, and serum creatine kinase level gradually improved after the administration of methylprednisolone intravenous. Cytomegalovirus infection was thought to have played a central role in this case, leading to an acute but reversible peripheral muscle paralysis.
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Previously, analgesics were avoided in suspected appendicitis to avoid masking the diagnosis. We determined use of analgesia in patients with appendicitis to determine recent trends over time and explore predictors of use of analgesia. ⋯ Use of analgesia and opioids analgesia has remained stable over time. Factors associated with prescription of any analgesia and opioids were older age and payment source. Use of CT was associated with prescription of analgesics.
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Letter Randomized Controlled Trial Comparative Study
Double-lumen tube tracheal intubation in a manikin model using the VivaSight Double Lumen: a randomized controlled comparison with the Macintosh laryngoscope.